What are ALL and LBL?

Hello. I am one of the bone marrow cells. My job is to develop into the cells that make the body perform its many functions.

Sometimes, bone marrow cells don't develop as they should. I will explain how this can lead to blood cancer.

There are many different types of blood cancers, but today we will focus on 2—acute lymphoblastic leukemia, or ALL, and lymphoblastic lymphoma, or LBL.

Our topics include how rare these blood cancers are and the role of asparaginase in treating them.

Leukemia is a broad term for cancer of the blood cells. Let's look at how normal blood is different from leukemia blood. In a healthy person, white blood cells called lymphocytes mature and help the body fight infection.

ALL and LBL are similar forms of blood cancer — can affect white blood cells, red blood cells, and platelets—but there are key differences.

ALL and LBL are caused when lymphoblasts, which are immature white blood cells, fail to mature into fully formed white blood cells called lymphocytes.

Blood cancer develops when immature lymphoblasts malfunction…and grow out of control.

An important difference between ALL and LBL is where the cancer cells are commonly found.

ALL affects white blood cells and platelets in the bone marrow.

LBL also affects the white blood cells, but does not start in the bone marrow. Parts of the body affected by LBL early on include glands such as the thymus and lymph nodes.

LBL is also extremely aggressive and can spread to other parts of the body very quickly.

In ALL and LBL, leukemia and lymphoma cells grow faster than healthy blood cells. So when these cells spread out of control, they can quickly outnumber the healthy cells your body needs.

How often do people get ALL and LBL?

ALL is a rare cancer. An estimated 6,540 people in the US will be diagnosed with ALL in 2023, which is less than 1 percent of all new cancer cases.

While rare, ALL is the most common type of cancer in children. More than 53% of the patients with ALL are 19 years old or younger.

LBL is an even rarer cancer. An estimated 1,600 people in the US will be diagnosed with LBL in 2023.

For ALL and LBL, an important treatment goal is removing a molecule called asparagine from a patient’s blood. Both healthy cells and cancer cells need asparagine to survive.

Asparagine is usually found inside the cells of the body, but it is also found in the blood stream.

Healthy cells can create their own asparagine, but cancer cells cannot.

Cancer cells need to get asparagine from blood to survive.

Asparaginase is a naturally occurring protein in the body that breaks down asparagine in blood.

Doctors use asparaginase as a medicine to treat ALL and LBL to break down asparagine in the blood, which causes cancer cells to die.

Asparaginase is just 1 part of a multi-drug treatment for ALL and LBL. Studies show that patients with high-risk B-cell ALL who received all of their asparaginase doses were less likely to have their disease return compared to patients who missed 1 or more asparaginase doses.

It is important to know that there are 2 types of asparaginase therapy approved in the US.

The first type is asparaginase derived from Escherichia coli, or E. coli.

The second type of asparaginase is derived from Erwinia chrysanthemi and is used when a patient has an allergic reaction to E. coli asparaginase.

We hope that this video gives you a better understanding of ALL and LBL and the role of asparaginase in the treatment of these conditions.

To learn more, talk to your healthcare team. They can address your questions or concerns and support you in making the best care decisions for you or your child.